Yoko Kojima

Recent diversity of human immunodeficiency virus type 1 in individuals who visited sexually transmitted infection-related clinics in Osaka, Japan

By human immunodeficiency virus type 1 (HIV-1) antibody screening of people who visited sexually transmitted infection (STI)-related clinics (venereology, urology, and gynecology) and were considered to conduct high-risk sexual activities for HIV-1 infection in Osaka, Japan, during 1992 to 2004, a total of 54 HIV-1 infected individuals (51 Japanese males and 3 non-Japanese females) were identified. Based on the sequencing at env-C2V3 and pol regions, Japanese males were mostly of subtype B (50/51 cases), with the one remaining case being a recombinant circulating form, CRF01_AE, while 3/3 viruses in non-Japanese females were of CRF01_AE. Analysis of subtype B cases since 2001 showed that these viruses became wider in their genetic variation, including amino acid insertions and also deletions, than that of the cases before 2000. Thus, it was suggested that HIV-1 spreading in Osaka has been increasing in genetic variability. Although all these infected individuals were first recognized to be infected with HIV-1 by our screening, some of them were carriers of HIV-1 with drug-resistant pol sequences, indicating that they could be infected with drug-resistant HIV-1 mutants.

A cluster of rapid disease progressors upon primary HIV-1 infection shared a novel variant with mutations in the p6gag/pol and pol/vif genes.

Few studies have described the etiologic factors associated with rapid AIDS onset during primary HIV-1 infection. Our molecular epidemiological study identified a cluster of individuals infected with HIV-1 variants characterized by novel mutations in the p6gag/pol and pol/vif genes during 2011 and 2013 in Osaka, Japan. Individuals positive for the novel HIV-1 variant showed rapid disease progression, suggesting a role of viral mutations in the fostering of the clinical course of HIV-1 infection.

Cases of HIV type 1 acute infection at STI-related clinics in Osaka.

Since 1992 we have investigated HIV antibodies in persons with a venereal disease who worked for a sex business or engaged in sexual behavior with a high risk of HIV infection at five clinics of venereology, urology, and gynecology in Osaka Prefecture. Starting at the end of 2000, we performed a nucleic acid-amplification test (NAT) on antibody-negative samples with the aim of detecting cases in the window period covering the early phase of infection. Three cases that were thought to be in this phase were found in 2006. All were confirmed to be positive in an NAT, although they were negative in initial screening for HIV performed using the IC method. Gene analysis of the env-C2V3 region of HIV-1 showed that the three samples had different origins.

Comparative evaluation of the GeeniusTM HIV 1/2 Confirmatory Assay and the HIV-1 and HIV-2 Western blots in the Japanese population

Accurate diagnosis of earlier HIV infection is essential for treatment and prevention. Currently, confirmation tests of HIV infection in Japan are performed using Western blot (WB), but WB has several limitations including low sensitivity and cross-reactivity between HIV-1 and HIV-2 antibodies. To address these problems, a new HIV testing algorithm and a more reliable confirmation and HIV-1/2 differentiation assay are required. The Bio-Rad Geenius™ HIV-1/2 Confirmatory Assay (Geenius) has recently been approved and recommended for use in the revised guidelines for diagnosis of HIV infection by the Center for Disease Control and Prevention (USA). We made comprehensive comparison of the performance of Geenius and the Bio-Rad NEW LAV BLOT 1 and 2 (NLB 1 and 2) which are WB kits for HIV-1 and HIV-2, respectively, to examine if Geenius is a suitable alternative to these WB assays which are now being used in HIV testing in Japan. A total of 166 HIV-1 positive samples (146 from patients with established HIV-1 infection and 20 from patients with acute infection), five HIV-1 seroconversion panels containing 21 samples and 30 HIV-2 positive samples were used. In addition, a total of 140 HIV negative samples containing 10 false-positives on screening tests were examined. The sensitivity of Geenius and NLB 1 for HIV-1 positive samples was 99.3% and 98.6%, respectively. Geenius provided more positive results in the samples from acute infections and detected positivity 0 to 32 days earlier in seroconversion panels than NLB 1. NLB 2 gave positive results in 12.3% of HIV-1 positive samples. The sensitivity of both Geenius and NLB 2 for HIV-2 positive samples was 100%. The specificity of Geenius, NLB 1 and NLB 2 was 98.5%, 81.5% and 90.0%, respectively. Geenius is an attractive alternative to WB for confirmation and differentiation of HIV-1 and HIV-2 infections. The adaptation of Geenius to the HIV testing algorithm may be advantageous for rapid diagnosis and the reduction of testing costs.

Mechanism of Inactivation of HIV-1 by the Freeze Pressure Generation Method (FPGM)

It has been reported that high-pressure (over 600 MPa) treatment at room temperature inactivates HIV-1, and have recently shown that high pressure generated by the expansion of water due to freezing (freeze pressure generation method, FPGM) has an inactivating effect on bacteria and HIV-1. In this study, we investigated the mechanism of the inactivation of HIV-1 by FPGM. The virus infective titer decreased to approximately 1/100 after treatment at –10°C (100 MPa), and below the detection limit after treatment at –20°C (200 MPa) or –30°C (250 MPa). The reverse transcriptase activity decreased to approximately 1/10 at –20°C or –30°C. In addition, we confirmed that the ability of the virus to bind to the surface of cells was lost by FPGM. The mechanism of the virus inactivation may involve virus enzyme damage and changes in virus envelope proteins.

[Detection of genotypic and phenotypic drug-resistant HIV-1 in patients receiving antiretroviral therapy].

We have analyzed the sequences of HIV-1 reverse transcriptase and protease genes in peripheral blood mononuclear cells obtained from patients receiving antiretroviral therapy to evaluate the drug resistance-associated mutations. Of 84 HIV-1-infected individuals treated with reverse transcriptase inhibitors, 43 (51.2%) have been found to carry amino acid substitutions predicted to acquire drug-resistances. One to 3 mutations at amino acid residues reported to be associated with protease inhibitor-resistance were detected in more than 80% of protease inhibitor-naive patients. However, these pre-existing mutations did not seem to raise a real resistance after the initiation of therapy with protease inhibitors. Phenotypic resistance assay was performed with 6 clinical isolates to compare with genotypic resistance. In most of the cases, phenotype was correlated with genotypic changes, however, two strains which were isolated from patients having no experience of chemotherapy showed a decrease in susceptibility to several drugs without any resistance-related mutations detected in their genes. Taken together, determination of phenotypic resistance is necessary, especially when a newly-infected patients starts antiviral therapy.